genital ulcers

Dermatology Dr. Hussein A. Al-Sultany
2016-2017
Genital Ulcer
Causes:
ST causes: herpes genitalis, chancre (primary syphilis), chancroid, lymphogranuloma venereum (LGV), and granuloma inguinale (Donovanosis).
Non ST causes: Behcet disease, fixed drug eruption, trauma, malignancy as SCC, and chronic infections as TB.


Syphilis
Definition:
Syphilis is a STI caused by a spirochetal bacterium ,Treponema pallidum, also called "Lues" or "Cupid s disease".

Mode of Transmission:
The infection is usually acquired through sexual contact with infected lesions or body fluids; less commonly, transplacentally; and rarely through blood transfusion, or inoculation with contaminated instruments (as tattooing or IV drug users).

Microbiology:
Treponema pallidum is a Gram negative, fragile, spiral bacterium (spirochete) with corkscrew rotation motility. It can be observed only by dark-field microscope, and unable to be cultured in vitro.
T. pallidum can cause the following diseases:
1. Syphilis: caused by T. pallidum pallidum.
2. Bejel (endemic syphilis): caused by T. pallidum endemicum. Transmitted non sexually, and has features of secondary syphilis without presence of the primary stage. Bejel is endemic in some areas in Saudi Arabia, Iraq, and Syria.
3. Yaws: caused by T. pallidum pertenue. It is a tropical disease characterized by an infection of the skin, bones, and joints.
4. Pinta: caused by T. pallidum carateum (vitiligo-like presentation).


Classification and Stages:
There are two types of syphilis congenital and acquired.

The Acquired Syphilis passes through four distinct clinical stages:
1. Primary stage (chancre).
2. Secondary stage (skin, mucous membrane, and systemic eruption).
3. Latent stage (history of syphilis + absence of signs and symptoms + positive serology).
It is divided into early latent (less than one year) and late latent (1 year or longer).
4. Tertiary stage (skin, mucous membrane, and visceral).

Early syphilis (within the first 2 years of infection, more infectious) including the primary, secondary, and early latent stages.
Late syphilis (after 2 years of infection, less infectious) including late latent and tertiary syphilis.